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Advanced diagnostics in action:
Identifying ocular surface disease
in cataract and refractive patients
Supported by unrestricted educational
grants from Allergan, Shire, TearLab, and
TearScience
Accreditation Statement
This activity has been planned and implemented
in accordance with the accreditation require-
ments and policies of the Accreditation Council
for Continuing Medical Education through the
joint providership of the American Society of
Cataract and Refractive Surgery (ASCRS) and
EyeWorld. ASCRS is accredited by the ACCME
to provide continuing medical education for
physicians.
Educational Objectives
Ophthalmologists who participate in this activity
will:
• List cataract preoperative screening tests
impacted by ocular surface disease
• Assess current and emerging OSD diagnostic
tools
• Differentiate between the various
therapeutic classes and treatments
Designation Statement
The American Society of Cataract and Refractive
Surgery designates this enduring materials
educational activity for a maximum of 1.0 AMA
PRA Category 1 Credits.
™
Physicians should
claim only credit commensurate with the extent
of their participation in the activity.
Claiming Credit
To claim credit, participants must visit
bit.ly/2pyQ2Id to review content and download
the post-activity test and credit claim. All
participants must pass the post-activity test
with a score of 75% or higher to earn credit.
Alternatively, the post-test form included in this
supplement may be faxed to the number indi-
cated for credit to be awarded, and a certificate
will be mailed within 2 weeks. When viewing
online or downloading the material, standard in-
ternet access is required. Adobe Acrobat Reader
is needed to view the materials. CME credit is
valid through December 31, 2017. CME credit
will not be awarded after that date.
Notice of Off-Label Use Presentations
This activity may include presentations on drugs
or devices or uses of drugs or devices that may
not have been approved by the Food and Drug
Administration (FDA) or have been approved by
the FDA for specific uses only.
ADA/Special Accommodations
ASCRS and EyeWorld fully comply with the legal
requirements of the Americans with Disabilities
Act (ADA) and the rules and regulations thereof.
Any participant in this educational program who
requires special accommodations or services
should contact Laura Johnson at ljohnson@
ascrs.org or 703-591-2220.
Financial Interest Disclosures
Eric Donnenfeld, MD, has an investment
interest in and has received a retainer, ad hoc
fees, or other consulting income from: AcuFocus,
AqueSys, Elenza, Glaukos, Icon Biosciences,
Kala Pharmaceuticals, Katena, Mimetogen,
NovaBay, Omeros, PRN, and TearLab. He has
an investment interest in: LacriScience, Mati,
Omega Ophthalmics, Ocuhub, Pogotec, RPS,
Strathspey Crown, TrueVision, and Versant
Ventures. Dr. Donnenfeld has received a retainer,
ad hoc fees, or other consulting income from:
Abbott, Alcon, Allergan, Bausch + Lomb, Bea-
ver-Visitec, Foresight, Novaliq, Shire, and TLC
Laser Centers. He is a member of the speakers
bureaus of: Pfizer, RPS, and TLC Laser Centers,
and he has received research funding from:
Alcon, Allergan, Bausch + Lomb, Beaver-Visitec,
Icon Biosciences, Kala, Omeros, PRN, and Shire.
Alice Epitropoulos, MD, has an investment
interest in NovaBay. She has received a retainer,
ad hoc fees, or other consulting income from
PRN. She is a member of the speakers bureaus
of: Allergan, Bausch + Lomb, BioTissue,
NovaBay, Omeros, RPS, Shire, TearLab, and
TearScience. Dr. Epitropoulos has received
research funding from: Bausch + Lomb, PRN,
TearLab, and TearScience, and has received
travel expense reimbursement from: Allergan,
Bausch + Lomb, and Shire.
John Hovanesian, MD, has an investment
interest in, has received a retainer, ad hoc fees,
or other consulting income, is a member of the
speakers bureaus of, has received research
funding and travel expense reimbursement from:
Abbott, BlephEx, Guardian Health Sciences,
Ocular Therapeutix, and Sight Sciences. He
has received a retainer, ad hoc fees, or other
consulting income, is a member of the speakers
bureaus of, has received research funding and
travel expense reimbursement from: Aerie,
Alcon, Bausch + Lomb, Katena, Omeros, Shire,
and TearScience. Dr. Hovanesian has an invest-
ment interest in: Alicia Surgical Center, Allegro
Ophthalmics, Allergan, Ivantis, MDbackline,
Sarentis Ophthalmics, and TLC Laser Centers,
and receives royalty or derives other financial
gain from MDbackline and Slack Books. He
has received a retainer, ad hoc fees, or other
consulting income from and is a member of the
speakers bureaus of: AcuFocus, Allergan, and
Ivantis. He has received consulting income from:
800Doctors, Sarentis Ophthalmics, and Videco
Medical Education, is a member of the speakers
bureau of Revision Optics, and has received
travel expense reimbursement from Ivantis.
Cynthia Matossian, MD, has an investment
interest in: PRN, Progressive Tech Training, RPS,
and Strathspey Crown. She is a member of the
speakers bureaus of: Abbott Medical Optics, Al-
con, Allergan, Bausch + Lomb, Bruder, Checked
Up, Imprimis, i-Optics, Lenstec, MARCO, Ocular
Therapeutix, Omeros, Shire, Sun Pharmaceuti-
cals, and TearLab.
Staff members: Kristen Covington and Laura
Johnson have no ophthalmic-related financial
interests.
Supplement to
EyeWorld June 2017
continued on page 2
by dry eye.
2
We are moving to-
ward routinely administering this
questionnaire to patients with
cataracts and performing objec-
tive diagnostic testing in those
with positive scores. We also test
asymptomatic patients with signs
of dry eye on examination.
Establishing protocols
A detailed dry eye questionnaire
is a good first step in understand-
ing a patient's symptoms. I use
the SPEED questionnaire: It's sim-
ple, questions are straightforward,
and it is fairly sensitive to visual
disruption and symptoms caused
N
early 80% of cataract-
age patients have dry
eye disease—a major
contributor to inaccu-
rate visual outcomes
after refractive surgery.
1
Whether
a patient is having LASIK or re-
fractive cataract surgery, postop-
erative uncorrected visual acuity
correlates strongly with patient
satisfaction.
However, patients in their
70s or 80s with advanced dry eye
may be asymptomatic because
the dry cornea becomes desen-
sitized over time. Consequently,
ophthalmologists are less likely to
treat conditions that do not cause
complaints unless they threaten
the patient's vision. However,
this is a mistake because even in
borderline cases with few signs or
symptoms, surgery may tip the
scales, triggering symptoms and
affecting refractive outcomes.
Whether patients seek
laser vision correction
or refractive cataract
surgery, untreated dry
eye can diminish visual
outcomes
by John Hovanesian, MD
Implementing advanced diagnostic protocols to identify
ocular surface disease and enhance refractive outcomes
John Hovanesian, MD
"
When implementing new
protocols, we cannot spend
enough time educating and
training staff.
"
–John Hovanesian, MD
Click to read
and claim
CME credit